Nottinghamshire STP Estates Workbook 21 October 2016 ... · Estates Workbook 21st October 2016...

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Nottinghamshire STP Estates Workbook

21st October 2016 Submission

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• The options set out in this document are for discussion purposes. The involved NHS bodies understand and will comply with their statutory obligations when seeking to make decisions over estate strategies which impact on the provision of care to patients and the public. The options set out do not represent a commitment to any particular course of action on the part of the organisations involved.

• In respect of any request for disclosure under the FoIA: This is a confidential document for discussion purposes and any application for disclosure under the Freedom of Information Act 2000 should be considered against the potential exemptions contained in s.22 (Information intended for future publication), s.36 (Prejudice to effective conduct of public affairs) and s.43 (Commercial Interests). Prior to any disclosure under the FoIA the parties should discuss the potential impact of releasing such information as is requested.

STP Estates Workbook - Disclaimer

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3. Contents

4/5. STP Service Strategy and Implications

6. Performance Indicators

7/8. Summary of Existing Projects

9. Sustainability & Transformation Initiatives

10/11. Implementation Priorities

12. Headline Financial Impacts – Investment and Disposal

13. Critical Decisions

14-22 Annex 1: Carter Metrics (Acute), NUH Programme & Basic Estates

Data

STP Estates Workbook - Contents

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STP Service Strategy & ImplicationsKey STP Service Strategy Themes:

The STP’s commitment was to close the financial gap of £628m by 2021

Main STP service priorities needed to deliver FYFV:

High Impact Areas

1. Promote Wellbeing, Prevention, Independence and Self-Care

2. Strengthen primary, community, social care and carer services

3. Simplify Urgent & Emergency care

4. Deliver Technology enabled care

5. Ensure consistent and evidenced based pathways in planned care

Supporting Work Streams

1. Improve Housing & Environment

2. Strengthen Acute Services

3. Drive System Efficiency & Effectiveness

Enabling Implications for Future Estate: Below (slides 3&4) will potentially produce £28.8M pa of savings towards the STP ask

1. NUH reconfiguration to maximise activity at QMC and significantly downsize City hospital will deliver over a 10 year period a circa 15% reduction across the overall NUH estate ( circa 50,000 sq.m) with estates revenue savings circa £15m. The East Midlands Trauma Centre is the catalyst for change which will be housed at QMC – Hot site.

2. Shared Service Collaboration - Acute Reconfiguration – Maximise QMC & KM and reduce City. Opportunity to consider sharing centralised services between SFH and NUH to deliver a more efficient future estate. Potential further 30,000sq.m reduction in floor area with circa £9m savings and reduction in backlog from demolition and disposal of buildings as part of reconfiguration.

3. SFH - Maximise utilisation of the long term core estate, Lift and PFI Estate – Mansfield Community Hospital, Newark (57% underutilised) , Ashfield Wellbeing Centre (65% underutilised), Kingsmill Hospital (Acute PFI- New build), Byron House and Highbury Hospital – Reducing voids of 811.37sq.m which is currently a cost of £509,000 pa & long term NHSPS lease estate. Saving additional £0.8K to £1M pa

4. Increased service delivery in primary, community estate (7 day access, diagnostics) – ascertain key estate hotspots for primary care and the development of proactive/clinical hubs with new care teams co-located into core estate. Link strategies with both ETTF NHSE capital injection and Section 106/CiL – GP Forward view

5. Urgent Care - Build and maintain Primary Care capability by co-location of GPs within A&E department at Kingsmill & QMC to continue with the successful ‘single front door access’ scheme established through the Better Together Programme

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STP Service Strategy & ImplicationsKey STP Service Strategy Themes:

Main STP service priorities needed to deliver FYFV:

Enablers

1. Workforce & Organisational development

2. Commissioning and System Governance

3. Estates Utilisation - accompanying slide

4. Communication & Engagement

Enabling Implications for Future Estate:

Priority areas to address are….

1. The acute reconfiguration work will also reduce outpatients departments in the acute & bed space to align with the shift of activity into the community

2. Further opportunities to reduce the footprint of estate through system wide disposals approx. £6.3m

3. Integrated primary, community, social care and mental health multidisciplinary teams (MDTs) working in formal network arrangements within a local clusters of practices to facilitate estate utilisation and 7 day working, maximisation of technological enablers and remote work will enable a reduction in non-priority estate through co-location

4. Respond to the Carter review and corporate services consolidation to support a potential reduction in floor area of administrative estate by 2,500 sqm. – 3,500 sqm . or between 70% and 100% of total floor area. Potential to reduce running costs by £1.3m – £1.5m , with required capital expenditure. Known schemes include the retraction from rented accommodation as Trust HQ within the Mid Notts footprint £0.8 to 1.0m

5. Working with the Health and Wellbeing Board, an engagement process is ongoing to help Local Authority Planners familiarise themselves with each Local Estates Forum to ensure that housing/business growth is captured through capital monies to support ongoing health infrastructure development – Mid-Notts CCG for Newark South have agreed £1.7m over 5 phases with developers for existing infrastructure upgrades

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Performance Indicators: 2020/21 Success Metrics Below is the system combined, Appendix 1 has a brea kdown of each Acute Trust. The view is that the STP submission at an integrated strategy level needs to be set at a level which includes a tolerance which takes into account the high level of detailed work still required (similar to optimism bias). This gives confidence in the acute delivering a net 15% saving. Note NHFT – Mental/Community Health Trust

Indicator Current Planned Comments

Estate Running Costs£m/2

£163.2M(£326m/2)

NHFT £24.5M(£166.15m/2)

£138M(275m/2)

NHFT £22.5M(£152.58m/2)

15% across both Trusts (Acute) 8% across NFHT Provider Trust data only

Non-Clinical Space (%)(Carter Metric max 35%)

See appendix 1 for individual Trust percentage

NHFT 31%

<31% Provider Trust data only

Unoccupied Floor Space (%)(Carter Metric Max 2.5%)

6.02NHFT 4%

<2.5 (2.0) NHFT by 2020. Provider Trust data only

Functional Suitability See appendix 1 for Acute NFHT 87% A&B, 13% C

See Appendix 1 for Acute NFHT 95% A&B by 2020

Eradication of non functional fit for purpose areas through the development of the Integrated Estates Strategy. Provider Trust data only

Condition See appendix 1NHFT 85% A&B, 15% C

NFHT 95% A&B by 2020 Acute: The PFI estate is maintained at condition B. Eradication of poor condition estate through the development of the Integrated Estates Strategy. Provider Trust data only

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Summary of existing projectsReview of existing projects /initiatives considered to align with STP (top 10/20 projects) Note: - Cash out + Cash saving

Project / Location

CCG StrategicObjective

Priority / Importance

Est Revenue impact£m (+/-)

Net Capitalimpact £M

(+/-)

Project Milestone

Estimated

DeliveryYear

STP Alignment (Y/N)

Acute reconfiguration will see a series of building blocks detailed on slide 18

STP Footprint

Aligning estate to STP clinical strategies (15-20% reduction)

High +£15M pa -(£576MNUH)

(£57.6M capital pa + CRL)

10 year period from 2017 –SOC in development

2027 Y

Shared ServiceCollaboration between NUH & SFH eg CSSD/ADU re-provision (pt. of the acute reconfiguration)

STP Footprint

Exit end of life assets, shared services collaboration. (further 30,000sqm floor reduction)

High +9M & potentially 14,7M (backlog)

-£65M 5 year period from 2017 –SOC to be developed following identification of sharedservices

2017 to 2022

Y

KMH, Newark –Estates Rationalisation and improved utilisation of high quality PFI estate

M&A Increased utilisationof assets incl. retained estate

High +£0.8K -£1M pa

-£81M SFH - FBC with Board

2021 Y

Children and Young Peoples site Development Mental Health (Specialist Service)

STP Footprint

Development of Children's & Young Peoples, Mother & Baby Services Provision

High -£300KAlready within NHCT two year plan

-£22M(disposes existing site)

Onsite 2017/18 Y

EMPAH – Pathology – EM Airport

STPFootprint

Deliver national and international service

High TBC TBC OBC 2017/18 Y

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Summary of existing projectsReview of existing projects /initiatives considered to align with STP (top 10/20 projects) - Cash out + Cash saving

Project / Location CCG StrategicObjective

Priority / Importance

Est Revenue impact£m (+/-)

Net Capitalimpact £M

(+/-)

Project Milestone

Estimated Delivery

Year

STP Alignment

(Y/N)

AlignPrimary/Community estate to service strategies/population growth

STP Footprint

New/improved estate to support Vanguard models, UC & Primary/Community strategy (PFI, Lift inclusive)

High -£4m Assumption+£2M offset based on NHFT

-£33.9m (ETTF) +s.106/CiLwhere possible

PiDs with Simon Stevens Team

2017 to 2021

Y

OllertonRegeneration model to improve health deprivation

Mid-Notts

One Public Estate agenda – clinical hub co-location with council lead services

High -£960kAssumption

-£8m assumption

Feasibilitystages

2018/19 Y

CCG HQ -Mansfield

Mid-Notts

Reduce cost of admin estate and abolish private landlord lease

High, +0.8m to£1m

TBC Feasibilitystages

2017/18 Y

CCG HQ -Balderton, Newark

Mid-Notts

Transfer of admin services to free space up for clinical demand in area –Newark South

High -120k based on £1m capital

Phase 1 of the £1.7m of s.106funding

Reviewing with Planners through LEF

2017/18 Y

Note: Est Revenue impact assumptions based on DH Lease Plus Agreement (Lift Model) i.e. 12% of Net Capital costs. This could be less if public capital is pursued through the One Public Estate initiative or through general Public Sector borrowing

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In order of priority - new projects identified where implementation required to enable wider STP strategy (revenue savings >£1m pa) - NOTE: Key major initiatives are already ongoing and are detailed on slides 7 & 8. In addition the STP are looking at 3 new further projects (initiatives) det ailed below

STP initiative Estates Impact and Enablers

Est. Net Revenue

Benefits (£m pa)

Project Status

Est. Deliver

Year

GrossCapital

Required (£m)

Disposalreceipts

(£m)

Comments and Interdependencies

System wide Demolition and disposals

Reduces redundant estate with capital/long term revenue gains

TBC SOC 2017 to 2027

TBC +£6.3M Helps to supportssystem estate alignment with footprint for service delivery

Urgent Care - Build and maintain PrimaryCare capability in the front door of A&E

Squeeze core &build new clinical hubs, 24/7 across footprint

TBC SOC 2017 to 2019

TBC TBC Primary Care setting at QMC new UC model –follows single front door access model

Various OPE schemes involving co-location between blue light services in planning stages

Co-location of East Midlands Ambulance Trust with Police, Fire to reduce estate

TBC TBC 2017 to 2019

TBC TBC Early planning stages which are a result of each LEF and OPE Steering Group for Notts footprint linked to the STP

Sustainability & Transformation Initiatives

Alternative sources of capital funding is being explored through Public Sector body partners i.e. Local Authorities and new Private Public Sector Partnership (PPP) modelling as detailed in the GP Foreword View that will help to implement the High Impact Areas and Support Work Streams of the STP set out within the main body of the submission

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Implementation prioritiesKey next steps towards delivery - Key major initiati ves are already ongoing and are detailed on slides 7 & 8

Key next step Challenges Resources Indicative timeline Comments

Acute reconfiguration will see a series of building blocks detailed on slide 18

Capital funding request above CRL threshold in discussing with Trust Board/NHSI. Investment needed to enable better use of estate to make savings

Project Board set-up, consultants employed with 10 year widow subject to NUH Board Approval

10 year estate with rolling programme 1- 5 years for clinical model

STP Implementation plan will work collaboratively with Trusts

Shared Service collaboration between NUH & SFH which incl. CSSD/ADU re-provision part of the acute reconfiguration

Identifying potential shared services and respective locations; Financials for any shared services

Will form part of the Project Board set-up for the Acute Reconfiguration

5 year estate rolling programme

Draft Business case from the proposed merger suggests £9.1m recurrent savings, however, there are significant one off costs required to enable these

KMH, Newark – Estates Rationalisation and improved utilisation of high quality PFI estate and retained estate

Alignment - STP agreeing the right services to be delivered within the deemed high cost estate

LEF acting as delivery group reporting to STPStrategic Estates Group linked with the Provider Alliance

1 to 3 years Retained estate at KMH and Newark forms part of the PFI contract. Need to assess removal and re-invest or reinvest through PFI

Align Primary/Community estate to service strategies/population growth

ETTF Funding – agreeing investment: Practice mergers: Alignment STP Footprint:Lack of alignment on service strategy for Mental Health: Workforce agreeing and delivering (clinical)


1 to 3 years Where ETTF is not successful, GP forward view use of PPP modelling needs exploring with links to probable combined investment between Trusts/Practices where possible

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Implementation prioritiesKey next steps towards delivery

Key next step Challenges Resources Indicative timeline Comments

Demolition and disposals, system wide

Public consultation,agreement to place capital receipts into system wide STP delivery to support delivery long term on its aim


2017 to 2020 Many sites at SOC stages

Urgent Care - Build and maintain Primary Care capability in the front door of A&E

Identifying the right sites across the footprint – estate that is deemed as being suitable i.e. Lift, long term leases, are in built up residential areas

Existing LEF to act as delivery group linked with the Provider Alliance &STP Programme Exec

2017 to 2020

Various OPE schemes involving co-location between blue light services in planning stages

Vehicle access in areas. Where there are PFI buildings involved, the long term costs added to an organisation for its accommodation. Disposal release of assets vacating i.e. the police have had issues with the Crown Estate due to restrictive covenant in the past

OPE linked in with LEF’s acting as delivery group. PMO will be set-up

2017 to 2019 At SOC stages to establish Co-location of EastMidlands Ambulance Trust with Police, Fire to reduce estate and sell for housing for regeneration

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Headline Financial ImpactsInvestment Pipeline summary

Disposal Opportunities – 10 in total identified – Housing unit estimates are assumption based at this stage

Investment requirement (strategic objective)

Estimated Investment capital £m

Committed(OBC stage)

Uncommitted(pre-OBC)

Estimated timeline

Capital Proceeds

£k

Gross Estate Running

Cost Savings £m pa

Service savings £m

Acute Estates Reconfiguration

576M N/a SOC 2027 TBC 15M 15M pa

Shared Service Collaboration between NUH & SFH which incl. CSSD/ADU re-provision

65M n/a N/a 2022 TBC 9M 9M pa & potentially

14.7M (backlog)

KMH, Newark – Estates Rationalisation

81M FBC N/a 2021 TBC 0.8K-1M 0.8K-£1M pa

Estate subject to ETTF (alignment of Primary Care)

33.9M N/a ETTF PiD 2017 to 2021

TBC TBC £2M(NHFT)

NHFT Backlog Maintenance

12.7M FBC N/a 2017 to 2021

TBC 100K 100K pa

Disposal Status

No. of sites

Land Area (Ha)

GIA(m)

Estimated disposal value £k

Timeline for

disposal (year)

Estimated Housing

Units

Gross Running

Costreduction £k

Cost to Achieve (where

known ) £k

Marketing ongoing

0

Declared surplus / OBC approved

9 TBC 3428 £4.5M+ (sites not valued)

2017 to 2021 93 354K+ Figures to be confirmed as list

takes shape

Feasibility Stage 1 3.8 TBC £1.8M 2017/18 80 10k Feasibility to sale26K

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Critical DecisionsDecision Required Significance/ impact on STP

strategic objectivesOwner Action By:

Acute Reconfiguration 10 year delivery plan will impact on STP delivery model if not agreed

NUH Exec

System wide disposals - How as a system we will pool resources and agree the Governance around this disposals

May reduce the ability to achieve some basic footprint project goals RE: capital receipts to support proposed system footprint goals

STP Exec

NHSE wanting all ETTF priorities and sign-off by STP exec i.e. do these fall in alignment with STP wide strategy (clinical)

Existing structure not designed for this; delays on delivery objectives assigned to both CCG’s strategies and STP models caused

STP/NHSE Exec

Confirmation of ETTF funded projects from the centre;identify scheme hub locations; lack of ETTF funding will need greater investment options which may not be welcome if not aligned to care models; GP practice mergers

Delays in practice mergers, or practices refusing to merge will delay hub and spoke hotspots;Organisational workforce may cause model of care to be fragmented

CCG/STPExec/NHSE

One Public Estate – Significant links to the STP - How as a system we will pool resources and agree the Governance around this i.e. disposals, joint funding, project delivery and co-location of workforce

Will impact on delivery model where co-location is needed as part of the High Impact and Supporting Themes – reduced funding benefits also

STP Exec/City Council

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Annex 1: Carter Metrics (Acute), NUH Programme & Basic Estates Data

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Performance Indicators: 2020/21 Success Metrics – SFHT


Estate Running Costs £52.94m £44.59m Occupancy cost. (-15.8%)

Non-Clinical Space (%)(Carter Metric max35%)

44% <35% Retraction of TB3 and utilisation of old wards 1, 2 and 3.


3090m2 (0.02%) <2.5% Although utilisation within the PFI is poor due to large corridors and circulation. (PWC/EY reports)

Functional Suitability 30% of the SFH estate retained estate. Incl. condition B and below condition B

Exit all ‘below condition B’ estate and all risk transferred

SPV (PFI contract)

Condition Acute: RAB £3.769m Acute: Nil

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Performance Indicators: 2020/21 Success Metrics - NUH


Estate Running Costs Total anticipated cost for financial year 2015/16 of £110,276,405.45. With a gross internal floor area of 360,337 m2 this equates to £306/m2 (rounded)

£306 - £320/m2 Current is below Lord Carter metric of £320/m2, which is positive, but it possibly reflects under-utilisation of the estate; as NUH space reduces and we become more efficient it is anticipated that the total expenditure will reduce but that the cost per m2 may rise as each m2 is sweated. Therefore increase over existing £306/m2 but remaining within Lord Carter metric.

Non-Clinical Space (%)(Carter Metric max35%)

34% 31% Following implementation of Estates Strategy


6% <2.5% Following implementation of Estates Strategy

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Performance Indicators: 2020/21 Success Metrics - NUH


Functional Suitability Significant improvement aspart of Estates Strategy implementation

Condition Only 58% of the estate achieves condition B.

Backlog

City Campus: £46.3mQMC Campus: £90.3m

Risk Adjusted

City Campus: £28.7mQMC Campus: £77.3m

Substantial reduction in high and significant risk backlog through the development & implementation of the NUH Estates Strategy

City Campus backlog reduced by circa £26m –from site demolitions / disposals / site rationalisation

Backlog figures are as per ERIC definitions i.e. exclusive of fees, VAT etc.

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Summary of existing projects – Indicative NUH 10 yea rTransformational Plan – Building Blocks Set-Out

Year 1 Year Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10

Building Block 1 – East Midlands Trauma

Centre -New build including Emergency

Department, Acute Assessment Unit,

Critical Care, Theatres and Helipad

Building Block 1 - Development Space

and Multi Storey Car Park (MSCP)

Building Block 2 – Re-alignment of

Family Health

Building Block 3 – Re-alignment of In-

Patient Services

Building Block 3 / 4 - Cancer and

Associated Services

Building Block 4 – Re-alignment of Out-

Patient Services

Building Block 5 – Re-alignment of

Corporate / Support / Facilities

Management Services. Rationalisation of

the estate

Trust(s) Ongoing Five Year Capital

Programme including Maintenance and

Critical Remedial Works

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Estates Composition (1 of 3)

Portfolio No. Properties

FootprintSize (Ha)

Size GIA (sqm)

Percentage Tenure split Freehold /

Leasehold

Estate Running costs pa (£m)

(rent, s’charge, FM)

Back-logMaintenance

£m

GP owned 194 TBC TBC TBC 11.1M TBC

NHS PS 59 TBC 85,060.74 44%FH, 44%LH, 2%PFI & 10% licence

21.1M TBC

CHP 12 TBC 43,649 Lift 14.1M £0

Provider estate (Acute) 5 71.87 501,153 SFHT PFI (140k) 163.2M 255.4M

Mental/Community HT 120 TBC 153,996 Freehold 24.5M 12.7M

Other 5,324 TBC TBC TBC TBC TBC

Totals 5,714 71.87 783,858.74 n/a 234M 268.5M

Functional Uses No. Properties

FootprintSize (Ha)

Size GIA (sqm)

Percentage Tenure split Freehold /

Leasehold


Back-logMaintenance

£m

Community FT Non Clinical TBC TBC 45983 Freehold 10.42 Non Clinical

Community FT Clinical TBC TBC 108103 Freehold 14.07 Clinical

Back Office (self contained unit)

8 TBC 8,800.11 Leasehold/Licence 3.16 None

Totals TBC TBC 162,886.11 n/a 27.6M n/a

Portfolio Summary – Other is assets known through One Public Estate programme, does not Incl. NHS. GP premises data has been extracted using NHS Premises 2015/16 data (SHAPE) - Data is a known issue that is in working progress – NHSPS Backlog is “subject to condition survey and ratification at present” – Provider data has been provided directly with sources i.e. Ha taken from SHAPE

Functional Use Summary – Offices based on NHS Proper ty Services data only which CCG’s rent/lease

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Highest Cost Sites

FootprintSize (Ha)

Size GIA (sqm)

Freehold / Leasehold


Back-logMaintenance £m

Cost per sqm

Current Site Strategy

QMC &City Hospitals

46.35 360,000 across

NUH estate

Freehold £110.3M Total = £136.6MRisk adjusted =

£106M

306 Optimise QMC, reduce City

Kingsmill 23.13 120,000 PFI 47.7M 12.8M 358 Optimise

High Cost Sites: Estate Running Costs – NUH figures are combined

Highest Cost Sites

Footprint Size (Ha)

Size GIA (sqm)

Freehold / Leasehold


Back-log Maintenance £m

Cost per sqm

Current Site Strategy

QMC &City Hospitals

46.35 360,000 across

NUH estate

Freehold £110.3M Total = £136.6MRisk adjusted =

£106M

For total backlog = £250m2

Optimise QMC, reduce

City

Kingsmill 23.13 120,000 PFI 47.7M 12.8M For totalbacklog =

107m2

Optimise

Highest Cost Locations : Backlog Maintenance

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Highest Cost Sites FootprintSize (Ha)

Size GIA (sqm)

Estimated Utilisation

(%)


Cost per sqm (GIA)

Proposed STP Site Strategy

King’s Mill Hospital 23.13 120,000 >80% 47.7M 358 Reduced GIA by 20%

*MCH TBC 10,232.34 <80% 6.3M 613 Increase utilisation - Figures from NHSPS

Newark Hospital 2.39 12,300 43% 4.4M 358 Better Utilisation, aligned with SFH Strategic Plan

HIGHBURY PFI TBC 17,826 75% 5.9M 333 Increase Utilisation

PFI Utilisation - LIFT Utilisation – Planned assessme nt of utilisation work through each LEF is currentl y be developed*Revised NHSPS figures

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Estates Composition (3 of 3)LIFT Utilisation – Planned assessment of utilisation work through each LEF is currently be developed

Highest Cost Sites FootprintSize (Ha)

Size GIA

(sqm)

Estimated Utilisation (%)

Estate Running costs pa

(£m)

Cost per sqm (GIA)

Proposed STP Site Strategy

GN LIFTBulwell RiversideClifton CornerstoneKeyworthMary PotterPark HouseStaplefordAspect House

NN LIFTAshfieldBaldertonBull FarmRainworthWarsop

1.310.770.131.140.610.47

0.640.680.860.440.25

836959312310799139956038978

19971663144513372073

NHS Space 53%NHS Space 44%

>80NHS Space 88%

>80>80TBC

50%50%TBCTBCTBC

1,549,512M2,277,710M873,365M

2,067,473M1,475,444M2,274,275M274,523M

819,776M662,481M487,819M545,018M823,087M

185384378259369377281

410421426408415

Optimise estate by reducing voids, increasing clinical delivery for increased utilisation by linking core estate with emerging care models detailed within the STP

Nottinghamshire STP Estates Workbook 21 October 2016 ... · Estates Workbook 21st October 2016...

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